Individual provider Active NPI

Lucas Hillman Wilson

  • Pediatric Cardiology Physician
  • Jackson, MS
National Provider Identifier
1346627544
Registry record updated Mar 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
29776 Issued in MS
Practice address
2500 N State St
Jackson, MS 39216-4500
Phone
(601) 815-2005
NPI assigned
Apr 27, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 52251 SC
Student in an Organized Health Care Education/Training Program 390200000X
Pediatric Cardiology Physician 2080P0202X 29776 MS Primary

Addresses

Primary practice location

2500 N State St
Jackson, MS 39216-4500

Mailing address

2500 N State St
Jackson, MS 39216-4500
Phone (601) 815-2005

Other practice location 1

2124 14th St
Meridian, MS 39301-4040
Phone (601) 553-6000

Other practice location 2

1102 Constitution Ave
Meridian, MS 39301-4001
Phone (601) 703-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, MS2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200210000788 SC Practitioner - Pediatric Medicine 7315254729 Reassigns benefits to 1 organization
I20220623000043 MS Practitioner - Pediatric Medicine 7315254729 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
University of Mississippi School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2500 N State St
Jackson, MS 39216-4500
Phone (601) 815-4775

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
52251SCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Associates of the Medical University of South Carol CurrentSince Dec 12, 2019 Accepting new patients
Anderson Regional Medical Center Current Accepting new patients
University Medical Associates of the Medical University of South Carol Current Accepting new patients
Anderson Regional Medical Center CurrentSince Feb 7, 2025 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Jun 22, 2022 Accepting new patients
Memorial Hospital at Gulfport CurrentSince Apr 7, 2023 Accepting new patients
Memorial Hospital at Gulfport Current Accepting new patients
Anderson Regional Medical Center Current Accepting new patients
Anderson Regional Medical Center CurrentSince Feb 7, 2025 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Jun 22, 2022 Accepting new patients
Memorial Hospital at Gulfport CurrentSince Apr 7, 2023 Accepting new patients

Locations

504 Clinton Center Dr
Ste 4300
Clinton, MS 39056

1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856

4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

1102 Constitution Ave
Meridian, MS 39301
Phone (601) 693-2511

2124 14th St
Meridian, MS 39301
Phone (601) 483-8811

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

Interoperability endpoints

  • Direct secure messaging: lwilson29213@ummc.direct-ci.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743120000000",
    "number": "1346627544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-2005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-2005"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2124 14th St",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "MS",
            "postal_code": "393014040",
            "country_code": "US",
            "telephone_number": "601-553-6000",
            "fax_number": "601-703-0124",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1102 Constitution Ave",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "MS",
            "postal_code": "393014001",
            "country_code": "US",
            "telephone_number": "601-703-5000",
            "fax_number": "601-703-0124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "LUCAS",
        "middle_name": "HILLMAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-27",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "52251",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "MS",
            "license": "29776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.